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1.
Early Hum Dev ; 191: 105976, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38452632

RESUMO

BACKGROUND: Patent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable. AIMS: To investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA. STUDY DESIGN: Retrospective, two-center, cohort study. SUBJECTS: Infants born at 22+0-25+6 weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220). MAIN OUTCOME MEASURES: Survival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). RESULTS: Surgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub-group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort. CONCLUSION: Earlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.


Assuntos
Displasia Broncopulmonar , Permeabilidade do Canal Arterial , Retinopatia da Prematuridade , Lactente , Feminino , Criança , Recém-Nascido , Humanos , Lactente Extremamente Prematuro , Permeabilidade do Canal Arterial/epidemiologia , Permeabilidade do Canal Arterial/cirurgia , Idade Gestacional , Estudos Retrospectivos , Estudos de Coortes , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/complicações , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/cirurgia
2.
Semin Perinatol ; 46(1): 151541, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34848064

RESUMO

Emerging data regarding the encouraging outcomes of extremely preterm infants from centers taking active approaches to the care of these infants have prompted dialogue regarding optimal medical management. Among the multitude of decisions providers make in caring for extremely premature infants is the prescribing of parenteral fluids. Surprisingly, there are limited data to guide evidenced-based approaches to fluid and electrolyte management in this population. Immaturity of renal function and skin barriers contribute to the impaired capacity of the preterm infant to maintain salt and water homeostasis. This perspective paper highlights developmental physiological properties of the kidney and skin, which the provider needs to understand to provide parenteral fluid therapy. Additionally, we provide recommendations for initial fluid and electrolyte management of the preterm infant based on novel data as well as the published literature.


Assuntos
Lactente Extremamente Prematuro , Nutrição Parenteral , Eletrólitos , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez
3.
Early Hum Dev ; 163: 105467, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34543945

RESUMO

INTRODUCTION: Respiratory care of extremely preterm infants remains a challenge. The majority require invasive mechanical ventilation (MV), which is a contributing factor in developing bronchopulmonary dysplasia (BPD). It is important to keep MV to a minimum but there have been concerns that attempting extubation too early increases the risk for atelectasis, re-intubation, and further lung trauma. The aim of this study was to compare two different approaches to extubation. METHODS: Single-center, retrospective cohort study including infants born at 22 + 0-25 + 6 weeks during 2005-2009 and 2011-2015, before and after implementing guidelines recommending delayed extubation. Primary outcomes were BPD, duration of MV and length of hospital stay. RESULTS: Eighty-eight infants in the early era and 102 infants in the late era were included. Infants in the first period were younger at first extubation attempt, and a higher number of infants were extubated within 24 h, 72 h, and one week after birth. The number of infants re-intubated and postnatal age at re-intubation did not differ between the groups. The incidence of severe BPD was 28% in the early period compared to 48% in the later (p < 0.01). Infants in the late period had longer duration of MV (17 vs 27 days, p < 0.01) but similar length of hospital stay (118 vs 123, p = 0.21). CONCLUSION: After implementing guidelines recommending delayed extubation, the incidence of severe BPD was higher and the duration of MV was longer. This supports the strategy to attempt extubation early even in extremely preterm infants.


Assuntos
Displasia Broncopulmonar , Extubação/efeitos adversos , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/prevenção & controle , Humanos , Incidência , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Respiração Artificial/efeitos adversos , Estudos Retrospectivos
4.
Arch Dis Child Fetal Neonatal Ed ; 106(4): 413-417, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33452221

RESUMO

OBJECTIVE: To determine survival and outcomes in infants born at 22-24 weeks of gestation in a centre with a uniformly active approach to management of extremely preterm infants. STUDY DESIGN: Single-centre retrospective cohort study including infants born 2006-2015. Short-term morbidities assessed included retinopathy of prematurity, necrotising enterocolitis, patent ductus arteriosus, intraventricular haemorrhage, periventricular malacia and bronchopulmonary dysplasia. Neurodevelopmental outcomes assessed included cerebral palsy, visual impairment, hearing impairment and developmental delay. RESULTS: Total survival was 64% (143/222), ranging from 52% at 22 weeks to 70% at 24 weeks. Of 133 (93%) children available for follow-up at 2.5 years corrected age, 34% had neurodevelopmental impairment with 11% classified as moderately to severely impaired. Treatment-requiring retinopathy of prematurity, severe bronchopulmonary dysplasia, visual impairment and developmental delay correlated with lower gestational age. CONCLUSIONS: A uniformly active approach to all extremely preterm infants results in survival rates that are not distinctly different across the gestational ages of 22-24 weeks and more than 50% survival even in infants at 22 weeks. The majority were unimpaired at 2.5 years, suggesting that such an approach does not result in higher rates of long-term adverse neurological outcome.


Assuntos
Lactente Extremamente Prematuro/crescimento & desenvolvimento , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/terapia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Retrospectivos
5.
J Perinatol ; 39(3): 409-414, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30617284

RESUMO

OBJECTIVE: To evaluate an implementation of lower oxygen saturation targets with retinopathy of prematurity (ROP) as primary outcome, in infants at the lowest extreme of prematurity. STUDY DESIGN: Retrospective cohort including infants born at 22-25 weeks of gestation in 2005-2015 (n = 325), comparing high (87-93%) and low (85-90%) targets; infants transferred early were excluded from the main analysis to avoid bias. RESULTS: Overall survival was 76% in high saturation era, and 69% in low saturation era (p = .17). Treatment-requiring ROP was less common in low saturation group (14% vs 28%, p < .05) with the most prominent difference in the most immature infants. Including deceased infants in the analysis, necrotizing enterocolitis was more frequent in low saturation era (21% vs 10%, p < .05). CONCLUSIONS: Implementing lower saturation targets resulted in a halved incidence of treatment-requiring ROP; the most immature infants seem to benefit the most. An association between lower oxygenation and necrotizing enterocolitis cannot be excluded.


Assuntos
Consumo de Oxigênio , Oxigenoterapia/métodos , Oxigênio/administração & dosagem , Retinopatia da Prematuridade/terapia , Feminino , Humanos , Incidência , Lactente Extremamente Prematuro , Recém-Nascido , Modelos Logísticos , Masculino , Estudos Retrospectivos , Suécia , Centros de Atenção Terciária
6.
J Perinatol ; 39(1): 39-47, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30353079

RESUMO

OBJECTIVE: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation. STUDY DESIGN: Retrospective, cohort study (2006-2015). Enrollment was limited to mother-infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother-infant dyads (comprehensive center); the other center (Nationwide Children's Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated. RESULT: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05). CONCLUSION: Even when mother-infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.


Assuntos
Idade Gestacional , Glucocorticoides/uso terapêutico , Doenças do Recém-Nascido , Terapia Intensiva Neonatal , Cuidado Pré-Natal , Ressuscitação/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/mortalidade , Doenças do Recém-Nascido/terapia , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Suécia/epidemiologia , Estados Unidos/epidemiologia
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